Project Summary/Abstract Nationally, prediabetes, a condition that if identified and addressed can prevent diabetes, remains alarmingly underdiagnosed and untreated. In North Carolina, it is estimated that 33% of adults have prediabetes while only 9% report having ever been diagnosed. Low levels of awareness result in missed opportunities to prevent new cases of diabetes and untreated prediabetes will increase already burdensome diabetes rates, with substantial economic impact. In North Carolina, diabetes prevalence among Black women and men is 15% and12.3%, respectively compared to a state prevalence of 10.9% and a White female prevalence rate of 9.8%. These outcomes could be explained by race and gender differences in prediabetes follow- up care, yet little is known about variations in prediabetes follow-up care by race or gender. Clinical guidelines were recently revised to improve screening rates for prediabetes and clinician response to abnormal values however, national practice guidelines often are not optimally adopted and little is known about how to increase identification and treatment of prediabetes in clinical settings. Understanding how clinicians implement clinical guidelines in practice and engage in prediabetes follow-up care is crucial in improving patient care. Understanding race and gender differences in screening and treatment of prediabetes can inform culturally relevant intervention studies aimed at reducing disparities. The proposed mixed methods study is a secondary analysis of electronic health record data within a large, academic health system accompanied by primary, qualitative data collection via in-depth interviews with clinicians and focus groups with patients with prediabetes. The specific aims of the proposed study are to: 1) Evaluate abnormal blood glucose screening rates and guideline concordant clinician response to prediabetes; 2) Assess barriers and facilitators of prediabetes screening and follow-up care within UNC Health Care. By combining quantitative and qualitative methods, the proposed study will thoroughly investigate patient, provider and healthcare system factors related to increasing adoption of diabetes prevention interventions. This study has been carefully designed to provide the applicant with robust opportunities to achieve her educational goals through completion of the dissertation and is aligned with AHRQ?s research priority area related to improving health care quality through the use of data resources that capture important actions and outcomes of health care to improve clinical practice and reduce disparities.